Pediatric malignant germ cell tumors show characteristic. Germ cell tumors most commonly appear in the testes for boys and the ovaries for girls. Serum alpha fetoprotein afp levels in normal infants. Between 1975 and 2010, childhood cancer mortality decreased by more than 50%. You will find out more about body changes and other things that can signal a problem that may need medical care. If you just found out that you or your child has a germ cell tumor, you may have a lot of questions about what it means and what comes next. Request pdf on researchgate pediatric germ cell tumor malignant germ cell. Sacrococcygeal germ cell tumors constitute the most frequent tumor in neonates, and extracranial germ cell tumors account for 14% of all cancers in adolescents of the 1519 age group. There are 2 types of staging for germ cell tumors, based on whether the patient has had surgery yet.
Human germ cell tumours gcts are derived from stem cells of the early embryo and the germ line. Patients diagnosed with this type of cancer make up only 4% of all cancers in children and adolescents less than 20 years old. Germ cell tumors may be cancerous malignant or noncancerous benign. Extracranial germ cell tumors are found outside of the brain. Home cancer types rare and related disorders germ cell tumors.
Keep in mind that the symptoms of a germ cell tumor may resemble other more common conditions or medical problems. In contrast, the most common germ cell tumor in children is a benign teratoma. Through time, these cells can grow into germ cell tumors, also called gonadal germ cell tumors. There are many kinds of germ cell tumors and only some. Germ cell tumors in the testes of an adolescent male commonly present as an enlarging, solid mass, which may be painful. For example, pediatric gcts, such as mature and immature teratomas, may not respond to chemotherapy. The large majority of testicular tumors in adolescents and adults are malignant germ cell tumors most commonly mixed germ cell tumors with pure seminomas occurring in older men. At birth, almost all tumors were teratomas, sometimes with microfoci of yolk sac tumor, which on the other hand, was the predominant histology during childhood. Children and adolescents with cancer should be referred to medical centers that have a multidisciplinary team of cancer specialists with experience treating the cancers that occur during. The benefits and limitations of therapy are related to differences in histology. Germ cell tumors health encyclopedia university of.
In the current study, data from the national cancer. Gcts that originate outside the gonads may be birth defects resulting from errors during development of the embryo. Declining childhood and adolescent cancer mortality. Germ cell tumours are a heterogeneous group of neoplasms that present across a wide age range and vary in site, histology, and clinical behaviour. Patients with germ cell tumours are managed by a diverse array of specialists. This handbook intends to describe the management of children and adolescents with germ cell tumors. Pdf testicular tumors in children and adolescents researchgate. In rare cases, childhood germ cell tumors can be passed down from one generation to the next. Germ cell tumors can cause a variety of symptoms in children based primarily on the size and location of the tumor. Germcell tumors in childhood and adolescence annals of. There are different stage descriptions for different types of tumors. Survival differences by raceethnicity among children and. Germ cell tumors are relatively rare compared with other malignancies, and compilations.
In adults 95% are benign and consist of mature cystic teratomas dermoid cysts. A germ cell tumor gct is a neoplasm derived from germ cells. Most of these tumors are benign teratomas in the sacrum or coccyx in older children, adolescents, and young adults 11 years and older, extragonadal extracranial germ cell tumors are often in the mediastinum. Germ cell tumors in children and adolescents gabriele calaminus, catherine patte introduction germ cell tumors gcts constitute a highly heterogeneous group of tumors that significantly varies with respect to site, clinical presentation, histology and biology. There are four main types of ogcts, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma. Testicular germ cell tumors are relatively rare in childhood and adolescence, accounting for only 3. During childhood and adolescence, approximately half of all germ cell tumors develop at extragonadal midline sites.
Sometimes, children with this type of tumor do not have any of these changes. Patients were identified from a database containing information collected prospectively on all patients with solid tumors. Germ cell tumors are also defined by how they look under a microscope andor the hormones they produce. The malignant germ cell international consortium was created to bring together pediatric, gynecologic, and testicular cancer specialists to. An estimated 430 malignant testicular germ cell tumors tgct will be diagnosed in boys aged 15 to 19 years in 2014, making it the fourth most common cancer in this age group. For example, pediatric gcts such as mature and immature teratomas may not respond to chemotherapy.
Gonadal and extragonadal germ cell tumors, sex cord stromal. According to the children s oncology group, the following pathologic stages are used for germ cell tumors. In children and adolescents, more than 60% of ovarian neoplasms are of germ cell origin, and one third are malignant. Tumors were histologically classified according to the who.
Gcts make up about 3% of malignancies in children aged 018 and nearly 15% of cancers in adolescents. However, the childrens oncology group cog developed the following system for staging germ cell tumors. The authors analyzed 153 cases of histologically verified intracranial germ cell tumors. Although germ cells are usually in the reproductive organs, these cells can sometimes travel to other parts of the body and cause tumors, called extragonadal germ cell tumors. Childhood germ cell tumors md anderson cancer center. Germ cells may travel to the chest, abdomen, or brain. Jan 06, 2014 purpose to determine whether overall survival os can be preserved for patients with stage i pediatric malignant ovarian germ cell tumor mogct with an initial strategy of surveillance after surgical resection. On imaging studies, benign germ cell tumors present as a heterogeneous, predominately cystic mass with solid components, well defined margins, and often calcification.
General information about childhood extracranial germ cell tumors gcts dramatic improvements in survival have been achieved for children and adolescents with cancer. Germ cell tumors acs atlas of clinical oncology derek raghavan on. Germ cell tumors in adolescents and young adults jco. Thirtyone patients with clinical stage i nsgctt were seen between 1980 and 2000. Trends in incidence and survival of pediatric and adolescent. Handbook for children with germ cell tumors american pediatric.
In humans, germ cells produce specialized cells needed for reproduction. A germ cell tumor may arise within the gonads in the ovary or testis. Germ cell tumors are rare, about 900 children and adolescents are diagnosed in the united states each year. Germ cell tumors can develop in the central nervous system, including the brain. Compared to children, adolescents with testicular tumor presented. In klinefelter syndrome 47, xxy there is an increased risk of developing mediastinal and, to a lesser extent, other extragonadal germ cell tumours. Epidemiologic and molecular evidence suggests that gcts in young children likely represent a distinct biologic group as compared to gcts of older adolescents and. Malignant germ cell tumors gct of childhood are rare and. During childhood, the majority of gcts present at nongonadal sites close to the. Germ cell tumors account for about 2 to 4 percent of all cancers in children and adolescents younger than age 20.
General information about childhood extracranial germ cell tumors gcts cancer in children and adolescents is rare, although the overall incidence of childhood cancer has slowly increased since 1975. Clinical stage i nonseminomatous germ cell tumors of the. Testicular tumors pediatric urology text book online. Symptoms vary depending on the size and location of the tumor.
Some germ cell tumors occur in other areas of the body, such as the abdomen, brain and chest, though it. Germ cell tumours in children and young adults childrens. Mediastinal germ cell tumor an overview sciencedirect topics. More than half of the tumors occur at extragonadal sites such as the ovaries 26%, the coccygeal region 24%, the testes 18%. Worldwide, the average annual incidence in children aged less than 15 years is 140 new cases per million children, although there are threefold variations between world. In the case of germ cell tumors located in the brain, the embryonic germ cells have mistakenly traveled to the brain, where they develop into tumors. They vary substantially in their natural history and show important clinical differences from their adult counterparts. Extragonadal germ cell tumors are made up of cells that form during the early development of a fetus unborn baby.
Gonadal germ cell tumors in children and adolescents. The tumor has been entirely removed, and tumor markers are normal. Germ cell tumors are growths that occur in children, teens and adults. Malignant germ cell tumors gct of childhood are rare and heterogeneous neoplasms thought to arise from primordial germ cells. Brain metastases of malignant germ cell tumors in children. Childhood and adolescent cancer statistics, 2014 ward. Germ cell tumors gcts are rare in childhood, representing only 3. Seventyfive 40 per cent of primary ovarian neoplasms in patients under 20 years of age were considered to be of non germ cell origin. Pediatric and adolescent extracranial germ cell tumors. In children younger than 11 years, extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Epidemiologic analysis of 1,442 children and adolescents.
Pediatric brain tumors diagnosis memorial sloan kettering. About 900 children and adolescents are diagnosed with germ cell tumors in the u. To perform a comparative assessment of the clinical and epidemiological aspects of testicular tumors in childhood and adolescence. In the developing embryo germ cells migrate to the ovaries or testicles and form the ova egg cells or sperm cells. A germcell tumor gct is a neoplasm derived from germ cells. Germ cell tumors can spread metastasize to other parts of the body.
In a growing fetus, germ cells typically move from a site near the middle of the body to the ovaries or testes gonads. Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain. Although germ cell tumors are rare in children under age 15, they are the most common solid tumors in adolescents, accounting for 14% of all cancers among those 1519 years old. The most common sites for metastasis are the lungs. This heterogeneous clinical presentation requires a multimodal treatment that. Germ cell tumors may be cancer malignant or not cancer benign. Germ cell tumors are growths that form from reproductive cells. Ovarian tumors of childhood and adolescence include a broad variety of clinically, histologically and biologically different entities. The most common sites for metastasis are the lungs, liver, lymph nodes, and central nervous system. Germ cell tumors of the ovary occur primarily in children and young women. Children s oncology group cog outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents. People with 46, xy and 45, x46, xy gonadal dysgenesis have a 10%50% risk of developing a gonadal germ cell tumour. Paediatric extracranial germcell tumours the lancet.
Pediatric germ cell tumors gcts are rare and heterogeneous tumors with uncertain etiology. In adults, the vast majority of germ cell tumors are benign nearly all mature cystic teratomas. Germ cell cancer is a rare tumor that affects children, teens, and adults. Patients and methods between november 2003 and july 2011, girls age 0 to 16 years with stage i mogct were enrolled onto childrens oncology group study agct02. They may also affect the brain, mediastinum, retroperitoneum, sacrum, or coccyx. We observed a bimodal age distribution with a first peak during infancy and a second after the onset of puberty. The majority of lesions in this group 53 arose from the coelomic epithelium or its derivatives and all were unilateral. Germ cell tumors can arise in young children, teens, and adults. Germ cells normally occur inside the gonads ovary and testis. Excellent outcomes are not distributed uniformly across the heterogeneous distribution of age, histologic features.
Germ cell tumors of the brain are a type of extragonadal germ cell tumor, but are treated differently than germ cell tumors in other parts of the body. Aug 11, 2016 childhood extracranial germ cell tumors gcts are very heterogenous. A germ cell is a type of cell that forms as a fetus unborn baby develops. The tumors usually affect the ovaries or testicles. Extracranial germ cell tumors make up about 3 percent of all childhood cancers for children under age 15. Request pdf survival differences by raceethnicity among children and adolescents diagnosed with germ cell tumors survival differences by racial and ethnic group have been reported in children.
Within the ovaries, germ cell tumors can usually be distinguished from ovarian cysts, which are much more common, using ultrasound. Cancers occurring in childhood and adolescence differ markedly from cancers in adults in their incidence and tumor characteristics. For information on a germ cell tumor in the brain, read about childhood central nervous system tumors. Germ cell tumors gcts arising in infants, children, and adolescents present a set of special challenges. Leading nonprofits in adolescent and young adult cancer.
Germ cell tumors may become clinically apparent in all age groups, ranging from the fetal period to adulthood. Surveillance after initial surgery for pediatric and. The histological diagnosis was germinoma in 63 patients 41. Amatruda is the principal organizer of an international meeting on germ cells, stem cells and germ cell tumors scheduled for march 2011, in dallas. Benign germ cell tumors include certain kinds of teratomas. A small number of children may develop longterm problems because of their cancer. Although not as difficult to deal with as malignant tumors, benign germ cell tumors can cause problems because of their size. Germ cell tumors in adolescents and young adults jco oncology. Part of the cancer treatment and research book series ctar, volume 10.
Dysgerminoma is the most common germ cell tumor, accounting for 50% of all germ cell tumor cases. Seminoma is a malignant neoplasm and the second most common mediastinal germ cell tumor that commonly occurs in men in the third or fourth decade of life. Germ cell tumors, as the name suggests, arise from germ cells, which during normal development of the embryo form into either egg or sperm cells. The outlook for children with germ cell tumours is good. Management of paediatric extracranial germcell tumours carries a unique set of challenges. The epidemiological patterns differ significantly from those in adult patients. Extragonadal germ cell tumors clinical presentation. Germ cell tumors that form in the brain are called intracranial germ cell tumors. Testicular germcell tumors are relatively rare in childhood and adolescence, accounting for only 3.
Teratomas of the tail bone are the most common germ cell tumor found in children, and are about four times more common in girls than in boys. Teratomas are usually benign, but some are malignant. Furthermore, most of them have accurate serum markers betahuman chorionic gonadotropin and alphafetoprotein, which provide in clinical stage i disease after semicastration a wait and see program. Germ cell tumors also may arise in extragonadal sites, reflecting the fact that germ cells travel to diverse areas of the body, such as the chest, abdomen, and brain. Most testicular tumors, in fact, are germ cell tumors. Childhood extracranial germ cell tumors treatment pdq pdq.
Billmire d, vinocur c, rescorla f, cushing b, london w, schlatter m, et al. As a member of the rare tumors steering committee at cog, he directly participates in the design and institution of clinical trials for childhood germ cell tumors and other rare tumors. The significant decline in childhood and adolescent cancer mortality in the early years of the 21st century is reassuring in light of concerns that childhood cancer mortality rates had plateaued after decades of consistent decline. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patients prognosis, which is the chance of recovery.
The classical epithelial pglycoprotein family of adults constitutes a rarity in childhood and adolescence. Germ cell tumours most often develop in the ovary or testicle because this is where most germ cells are. The aim of this study was to perform an evaluation of outcome and the role of surgical staging components in malignant germ cell tumors gct of the ovary in children and adolescents. Childhood central nervous system cns germ cell tumors form from germ cells a type of cell that forms as a fetus develops and later becomes sperm in the testicles or eggs in the ovaries. A teratoma is a tumor that may contain several different types of tissue, such as hair, muscle, and bone. Some tgct also occur in boys aged younger than 4 years fig. The most common location of these tumors are the ovaries in females or testicles in males. Thus, staging, risk stratification, and treatment approaches for germ cell. Germ cell tumors gcts are the third most common cancer diagnosis in adolescent and young adult aya patients aged 1524 years. These are the cells in the body that develop into sperm and eggs. Germ cell tumors danafarberboston childrens cancer and. Testicular germcell tumors in childhood and adolescence. Histology of malignant germ cell tumors in children, adolescents, and young. A child with an extracranial, extragonadal germ cell tumor may experience the following symptoms and signs.
Childhood central nervous system germ cell tumors treatment. Retrospective analysis of medical records of patients with. It is based on current literature and accepted practice. Success has been achieved primarily through the application of platinumbased chemotherapy regimens. Paediatric extracranial germcell tumours the lancet oncology. Management of paediatric extracranial germ cell tumours carries a unique set of challenges. They make up only 4% of all cancers in children and adolescents. Because germ cell tumors can vary greatly, and can arise in different parts of the body, they can be difficult to stage. Many cancers that arise in aya patients, including gcts, are defined as rare because they are relatively infrequent during early childhood and older adulthood. Malignant ovarian germ cell tumors occur in the first four decades and are rare thereafter. Extragonadal germinal cell syndromes are rare tumors that predominantly affect young males. Germ cell tumors are most common in children and young adults, there are different subtypes including endodermal tumors mostly found in children, dysgerminoma, teratoma, and seminoma young men. Occurring most frequently in children, germ cell tumors comprise several different types of tumors including germinomas, endodermal sinus tumors, and choriocarcinomas.
Ovarian germ cell tumors ogcts are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2. However, they have become a model for curable cancer. More than half of the tumors occur at extragonadal sites such as the ovaries 26%, the coccygeal region 24%, the testes 18% and the brain 18% represent then primary sites. Germ cell tumors occur where these cells start to grow in abnormal or uncontrolled way. Most germ cell tumors that are cancerous occur as cancer of the testicles testicular cancer or cancer of the ovaries ovarian cancer. Germ cell tumors danafarberboston childrens cancer. Childhood extracranial germ cell tumors treatment pdq. The tumor has been entirely removed, and tumor markers are normal, or return to normal after surgery. Germ cell tumours in children and adolescents sciencedirect. In children and adolescents, 60% of ovarian neoplasms are of germ cell origin, of which are malignant.
The following represents disclosure information provided by authors of this manuscript. Germ cell tumors starting within the brain are discussed further under brain tumors. The term germ cell comes from the term geminate, which means giving life. Methods from 1990 to 1996, 2 intergroup trials for malignant gct were undertaken by pediatric oncology group pog and children s cancer study group ccg. Pediatric germ cell tumor request pdf researchgate. Children will have regular followups to check for any recurrence of the cancer and for any problems which may arise as a result of the treatment they were given. But germ cells can sometimes be left behind in other parts of the body from when you developed in the womb. Epidemiologic and molecular evidence suggests that gcts in young children likely represent a distinct biologic group as compared to gcts of older adolescents and adults.
Childhood extracranial germ cell tumors gcts are very heterogenous. Among children younger than 15 years, gcts are comparably rare and account for approximately 34% of all diagnoses enrolled onto epidemiologic registries. Nationwide childrens hospital germ cell tumors in children. During the past 35 years, survival rates for children with extracranial malignant germ cell tumors gcts have increased significantly.